=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033248059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORT THOMPSON IHC CLINIC PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 03/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HWY 47 AND HWY 34
-----------------------------------------------------
City | FORT THOMPSON
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-245-1545
-----------------------------------------------------
Fax | 605-245-2384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3098 SOLUTIONS CTR
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60677-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY PROGRAM SPECIALIST
-----------------------------------------------------
Name | JAMES CUMMINGS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 405-951-6086
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332800000X
-----------------------------------------------------
Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------